Background: Compared to other regions of the United States, people living in Appalachia bear a heavier burden from obesity related chronic conditions such as cardiovascular disease, stroke, diabetes, fibromyalgia, and sleep apnea as well as higher rates of premature mortality for those diseases. Childhood obesity in particular poses a burgeoning and understated threat to the public health system. Objectives: The purpose of this study was, working with the Appalachian Funders Network, identify the policies and practices that have a positive impact on the reduction of childhood obesity and chronic disease in central Appalachia (TN, VA, KY, WV, NC, and OH). Methods: Mixed methods approach was utilized. Survey of practitioners and funders identified efforts to reduce childhood obesity including obesity prevention, healthy eating and/or physical activity. Focus groups conducted across the region provided participant generated strategies to address gaps and needs. Results: Over 400 practitioners and 40 funders completed the survey. Eight focus groups were conducted across central Appalachia. Based on the finding, a set of recommendations to inform future grant making strategies will be compiled. Preliminary results demonstrate some areas of disconnect between funders and practitioners. Programs were more sustainable if funded from within the community rather than from an outside source. Further, the success of a program seems to be based on need and the collaboration of the practioners and funders. Conclusions: Using a mixed-methods approach, an aggregate of data provides a comprehensive picture of the current health condition of central Appalachia. Working with the Appalachian Funders Network, a group of 80 funders, the findings from this study have the potential to impact the work on practitioners and funders in the region. This collaboration hopes to promote a sustainable healthy lifestyle within Tennessee and greater Appalachia.

Abstract available through the Annals of Behavioral Medicine.

With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.

Background Discrimination is a pervasive societal issue that monumentally impacts people of color (POC). Many Black, Asian, and Hispanic/Latinx individuals report experiencing race-based discrimination in their lifetime. Discrimination has previously been linked to adverse health outcomes among POC, including stress, depressive, and posttraumatic stress disorder symptoms. These health disparities are posited to have become exacerbated by COVID-19 and the racial awakening of 2020. The current study examined the short- and long-term effects of discrimination on stress, depression, and oppression-based trauma among POC. Methods Participants were (n = 398) who identified as Black, Indigenous, Hispanic/Latinx, and Asian completed an online self-report survey assessing discrimination, depression, stress, and oppression-based trauma collected at 3 time points: (T1) beginning of the COVID-19 pandemic (May 2020), (T2) 6 weeks later during the racial awakening of 2020 (June 2020), (T3) one year later (June 2021). Results Significant positive paths were revealed from T1 discrimination to T2 depression, T2 stress, and T3 oppression-based trauma. The association between T1 discrimination and T3 oppression-based trauma was partially mediated by T2 depression, but not by stress; total and total indirect effects remained significant. The final model accounted for a significant proportion of the variance in T3 oppression-based trauma, T2 depression, and T2 stress. Conclusion Findings are consistent with prior research linking discriminatory experiences with mental health symptomatology and provide evidence that race-based discrimination poses harmful short-and long-term mental health consequences. Further research is necessary to better understand oppression-based trauma to improve the accuracy of clinical diagnosis and treatment of POC.

Submitted by William Justo Figueiro (williamjf) on 2015-06-26T22:42:59Z No. of bitstreams: 1 42.pdf: 1869732 bytes, checksum: 20e93c264df16927ef25141a7e2f2520 (MD5) / Made available in DSpace on 2015-06-26T22:42:59Z (GMT). No. of bitstreams: 1 42.pdf: 1869732 bytes, checksum: 20e93c264df16927ef25141a7e2f2520 (MD5) Previous issue date: 2009-08-28 / Nenhuma / O objetivo desta dissertação é identificar como a experiência do cliente de uma empresa de saúde suplementar pode se refletir na gestão organizacional, sob o ponto de vista da organização. As relações entre a teoria e a prática seguem duas grandes linhas: as operações em saúde realizadas diretamente por cada unidade e o relacionamento com o cliente. O estudo, de caráter qualitativo e exploratório, se desenvolveu por meio de estudo de casos de organizações distintas, mas pertencentes a uma mesma confederação nacional localizadas em diferentes regiões do estado do Rio Grande do Sul. As empresas de saúde suplementar têm como seu produto mais comumente comercializado o “plano de saúde”, e sua função é a ligação entre o cliente o prestador do serviço. Para o estudo foram realizadas 16 entrevistas e observação posteriormente confrontadas. As operações foram classificadas de acordo com sua função para a manutenção da saúde do cliente em proteção, prevenção, cuidado e reabilitação conforme as ações de saúde propostas por Alma-Atta (1978). Identificou-se a predominância dos serviços enquadrados em prevenção e cuidado. No relacionamento com o cliente, busca-se identificar qual a forma ou formas que estas organizações se relacionam com o cliente. Observou-se a intenção de conhecer o cliente por meio da atenção à sua verbalização e a partir do acompanhamento do seu comportamento na interação com a organização. O reflexo da experiência do consumidor parece apresentar duas formas distintas: a melhoria incremental de serviços, já bem estruturada, e criação de novos serviços a partir do acompanhamento do comportamento do consumidor. / The goal of this research is to identify how the customer experience of a private health care company can be reflected in the organizational management, under the organization point of view. The study presents a qualitative and exploratory approach, using case studies of different health organizations all part of one same national confederation in different regions of the state of the Rio Grande Do Sul. The relations between the theory and the practice followed two main lines: The health services provided by those different units and its relationship with the customer. The private health care companies have as its main product “the health plan” and its function is provide the link between the customer and the health service provider. In this research, were made and studied 16 interviews and observations. The operations had been classified, in accordance with its function for the maintenance of the customer health, in: Protection, Prevention, Care and Rehabilitation, according the health actions proposed by Alma Atta (1978). It was identified de predominance of Prevention and Care services. Regarding the relationship with the customer, the Idea was to identify the way or ways how these organizations relate with their customers. It was observed intention of knowing the customer trough the attention to its observations and by following the customer behavior in the interaction with the organization. The consequence of the customer experience seems to present two distinct outputs. The improvement of the existing services and the creation of new ones.

No description available.

Although patterns of African American and white women breast cancer incidence and mortality in St. Louis, Missouri is consistent with those seen elsewhere in the United States, rates vary greatly across zip codes within the city of St. Louis. North St. Louis, whose neighborhoods are primarily African American, exhibits rates of breast cancer mortality that are among the highest in the city and higher than the state as a whole. Based on information that up to 50% of women in North St. Louis with a suspicious diagnosis of breast cancer never enter treatment, we conducted three 2-hour group model building sessions with 34 community stakeholders (e.g., breast cancer survivors or family members or caregivers and community support members such as navigators) to identify the reasons why African American women do not begin or delay breast cancer treatment. Participant sessions produced a very rich and dynamic causal loop diagram of the system producing disparities in breast cancer mortality in St. Louis. The diagram includes 8 major subsystems, causal links between system factors, and feedback loops, all of which shed light on treatment delays/initiation. Our work suggests that numerous intersecting factors contribute to not seeking treatment, which in turn may contribute to African American and white disparities in mortality.

The application of sport science is crucial to athlete performance development. However, the frequent disconnection among sport scientists, coaches, and athletes often leads to miscommunication and increased potential for performance barriers. The creation of sport performance enhancement groups (SPEGs) can help with the professional integration and communication among all personnel involved in the training process. However, SPEG formation faces a number of barriers in the current coaching landscape. The application of a benefits-based programming (BBP) model may aid in the formation of an SPEG and the dissemination of education for coaches, athletes, and administrators. A field experience involving the BBP model and SPEG creation in a National Collegiate Athletic Association (NCAA) Division II school is presented with multiple model iterations

Thesis (Dr.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 1983. / Typescript. Dissertation Abstracts International order no. 84-08513. Includes bibliographical references (leaves 140-143).

Orientador: Jorge Hamada / Banca: Rosane Aparecida Gomes Battistelle / Banca: Valdir Schalch / Resumo: Este trabalho aborda como tema principal a situação da geração, segregação e disposição final dos Resíduos de Serviços de Saúde na região do Coder (Conselho de Desenvolvimento Econômico Regional) que tem como sede o município Bauru. O objetivo foi levantar dados, avaliar a situação atual da questão dos RSS e propor soluções para uma melhor gestão deste tipo específico de lixo urbano. Ao cumprir tais objetivos, as considerações expostas pelo autor levam a um retrato da situação atual dos resíduos de serviços de saúde na região, trazendo também um panorama do tema no Brasil e no Estado de São Paulo, expondo as fragilidades das leis que contemplam mais os grandes geradores e a baixa qualificação da mão de obra, o que diminui o processo de segregação e, no destino final, problemas ambientais. / Abstract: The theme of this work is about generation, segregation and final disposal of Health Services Residues (RSS) in the region of CODER (Regional Economic Developing Council), which is based in Bauru. The aims of this research are to improve the management of this specific type of urban waste. In order to accomplish such objectives, considerations made by the author of this dissertation show a portrait of the actual situation of the RSS in the region researched and a panorama of the theme in Brazil and in São Paulo state. It possible to observe in this work the weaknesses of the laws that serve mostly big generators of waste and the low qualified work force, which diminishes the quality of segregation process and environment problems during the final disposal of the waste. / Mestre